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Right now, folks dream of Thursday and all the mashed potatoes, gravy, stuffing and turkey the holiday offers. Local Flavor loves a Thanksgiving meal just as much as the next person, but today it’s all about the other white meat: pork.
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Janine Starinsky, executive director at Oakwood Terrace, has worked at the center since it opened 15 years ago.

Janine Starinsky likes to say that if you've met one Alzheimer's patient, "you've only met one."

"Each one is different," said Ms. Starinsky, M.H.A., C.D.P., C.C.D.M.

Given these circumstances, it's crucial for families to do their homework before deciding what type of long-term care their loved ones require, whether it's home health or adult day care, respite, independent living or assisted living, skilled nursing or hospice.

"Dementia care is a field in itself," said Ms. Starinsky, executive director at Oakwood Terrace, a personal care/assisted living center in Moosic and one of only a few in the region focusing specifically on dementia.

"Most people are in denial, or embarrassed, that they have some kind of memory problem," she continued. "The most important thing before anyone starts panicking is finding the proper diagnosis. There's nothing worse than being diagnosed with dementia and going into a residential community and finding out it's depression, not dementia."

In the early stages of Alzheimer's, most people can still carry on more or less independently. It's when they begin leaving the stove on or forgetting where they're driving or wandering the neighborhood that they then require personal care, Ms. Starinsky said.

"But the willingness to go into a secure facility is a challenge: the arguing, the guilt of the caregiver," she said. "It's most difficult on the caregivers. Would you want someone to go into a bathroom with you while you're stark naked?"

Instead of promoting task-oriented programs, Oakwood's staff practices a person-centered approach to dementia care that uses validation techniques and questions, rather than statements. Activities focus on the individual's own skills and past experiences to deal with his or her dementia. Several staff members have been trained in the Montessori-based Dementia Programming (MBDP) through the Myers Research Institute.

Oakwood sits on a large, flat property that residents are free to roam. There's a 24-hour security and surveillance system, as well as alarms on all exit doors, "so if they go outside, we know," Ms. Starinsky said.

"It's a gated community. They can go out and explore the outdoors freely," Ms. Starinsky said. "They can still get around, they just may need some verbal cueing. It's our job as caregivers to find that solution for them, to help them determine what they need."

As the disease progresses into its later stages and residents begin to diminish in their capabilities - i.e., losing the ability to feed themselves or get around - families usually then pursue skilled nursing or hospice placement, Ms. Starinsky said.

Allied Skilled Nursing & Rehabilitation Center in Scranton uses a team approach to develop care plans for each of its 61 patients, according to Laura Piazza, the facility's vice president and administrator.

Like Oakwood, the center has occupational, physical and speech therapists on staff who assess each patient to determine the individual's skill level. Dietitians and social workers also will do assessments of the patients, as does the nursing staff. After a care plan is put in place, all staffers will encourage patients to continue walking, speaking, feeding themselves and socializing with others.

"Our main goal is to maintain each patient's highest functional ability," Ms. Piazza said. "The longer we can preserve their skill level, the slower the disease progresses."

The team also continues with regular assessments to make sure the care plan is effective and the patients' needs are being met. But even with the best care, Alzheimer's patients will decline over time because of the nature of the disease.

When the Allied staff notices a decline in a patient's condition, Ms. Piazza said, the staff will try to pinpoint what is causing it and then decide how to address the problem. For those losing their ability to speak and eat as the disease progresses, speech therapists work with patients to learn verbal cues to help them chew and swallow food, therapist Chris Minich said.

Another focus is helping patients remember the past and make friends in the unit. Staffers said it is heartening to see patients make their way to the day room in the morning to find their friends.

"They sit in the same spot with their friends and play card games or work on puzzles together," said nursing unit manager Kim Yablonski.

In addition to his practice, Scranton physician Patrick Conaboy, M.D., serves as medical director at Lackawanna County Healthcare Center and Holy Family Residence, as well as the outpatient medical director for Mercy Hospice. Every day, he sees the dedication and compassion Alzheimer's unit staffers bring to their work.

"It takes a real special person to run these units," Dr. Conaboy said. "They're special people who form really tight relationships with these patients."

Family caregivers are also a hugely important part of the equation. Like the patients, their world is altered in numerous ways, said Ms. Starinsky, noting many of them end up completely cutting out their personal network in the process of caring for their loved ones.

It takes a heavy toll on their psyches, she said.

"It's important for caregivers to cut back, but not cut out," Ms. Starinsky said. "We need to realize we can't fix the problem; we just need to know how to facilitate it. The challenge is to try to educate the caregivers and think outside the box.

"Love and comfort - if you can provide that (to the patient), along with safety, that's all they need."

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